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MY VIEW


Teledentistry: Not Just for Public Health Dentists Applications to Consider for Private Practices


by NATHAN SUTER, DDS T


eledentistry is a tool that has been used by many dentists for more than a decade


to reach the most vulnerable and underserved patients, both rural and urban. Diagnosing and treatment planning patients remotely, by having a trained and trusted dental hygienist, has been how I have performed teledentistry for years. A well-calibrated team can confi- dently, and with a high amount of accuracy, provide a much-needed way for a person to begin accessing dental care.


When I began to use the technology, it was being done in many parts of the country, in a little more than a dozen states where it was allowed. I had increasingly been asked to present my experience to groups a few times a year, but mostly in front of dentists in a public health setting. I had tried, with no success, for years to bring this tool to the attention of many leaders in the dental industry. I sent LinkedIn messages and cold- called individuals. I spent countless hours with manufacturers trying to convince them how existing products—with some modifica- tions—could greatly increase functionality and be used for teledentistry. I had seen the potential in a public health setting where I first became aware of it, but now for the past two years in my private practice, I have been using teledentistry to supervise my hygiene chair a couple of times a month on average. My estimate is that teledentistry for hygiene- only days added around 22 hours a month to my schedule or a 22 percent increase. And it was working out great for my small practice … then COVID-19 swept across the world.


I already had been planning to use teledentistry in early March to address COVID-19 in my practice. I was about to ex- plain the plan in our Monday morning huddle when I got a call from one of the larger dental insurance companies. They needed help


18 focus | MAY/JUN 2020 | ISSUE 3


understanding teledentistry and desired a “subject matter expert”. I had been in contact with most major plans for years trying to get statements in regard to insurance coverage for teledentistry with little suc- cess. In my public health work, many of these payors declined years of requests to fund pilot programs around teledentistry. This call was a turning point for me. In the last four weeks since that call, I have had the opportunity to present on teledentistry for more than 5,000 dental professionals in groups like the ADA, NDA, Henry Schein, Dentaquest Partnership, Arcora Foundation, and numerous other manufacturers, plus state and national organizations. The majority of these attendees are private practitioners wanting to catch up with teledentistry tech- nology, now that they see their workflow may need to change and that they could benefit from the adopting the technology.


Luckily the American Dental Association, in concert with the major dental insurance plans, moved quickly to clearly indicate that they would cover what many now are calling Virtual Limited Evaluations and Triage. This isn’t the type of teledentistry I have been teaching people to use for the past few years—this is an entirely different animal and is limited as the name indicates. This involves a dentist virtually extending their clinical practice to reach patients in quarantine in their own homes. The main goal of this mo- bilization was to reach a patient where they are and to triage their needs while dentists helped to “flatten the curve”. This has proven to be very useful for myself and my patients, as well as all of the new patients I have been


reaching as the only dentist in the area pro- viding such a service.


As dentists make decisions on how to re- open, I would like to share how teledentistry has an important part it can play in the short- and long-term. The immediate application for teledentistry is to mitigate risks in a world where a lot is uncertain. Teledentistry can do that by providing a safer environment for patients to re-engage dental care. This can be explained in two applications.


Limited evaluation and triage: The latest recommendations from the ADA and CDC include thorough screening of patients before having them enter the dental office. Most dentists that I have personally helped to set up a direct-to-patient teledentistry system have asked for a video conferencing solu- tion. We call that a synchronous or real-time interaction with the patient. This is the most genuine and real way you can communicate with patients and do a teledentistry exam. When establishing relationships with new patients in particular, this is very helpful;


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